Dermatology Expert’s Advice Not Just Skin Deep

When DIABETES HEALTH Board Member Gary Arsham, MD, heard S. William Levy, MD. give a lecture on diabetes and its effects on skin, he was impressed.

“I realized that this doctor is the most knowledgeable person on diabetes and skin that I have ever heard,” Arsham said.

Indeed, Levy is one of the world’s experts on diabetic skin conditions, with over 40 years experience in the area.

Levy became interested in skin complications related to diabetes in 1953 after finding a significant link between amputations and diabetes. Since then he has worked at hospitals throughout San Francisco and has written several books and journal articles on the subject he knows best-skin.

Skin complications are especially important to people who have diabetes-30 percent of the 16 million Americans with diabetes develop skin disorders.

Levy reports that 54,000 amputations a year occur due to skin ailments, 90 percent of which could be prevented by early detection.

We caught up with Levy recently and invited him to answer a variety of questions that people with diabetes ask in relation to their skin.

DIABETES HEALTH: Why do people with diabetes tend to have higher incidence of complications with their skin than those without diabetes?

Levy: Nobody really knows, but many believe it is due to a narrowing of the smaller blood vessels near the skin (microangiopathy). These smaller blood vessels protect the skin in non-diabetics. But in people with diabetes, they become constricted and may even become completely clogged through the years.

Because of the restricted blood supply, things don’t heal very quickly and can lead to infection. When this happens the tissues dry up, gangrene can set in, which may eventually lead to amputation. Remember, even simple bites and scratches can lead to ulceration (a sore on the surface of the skin.)

DIABETES HEALTH: Why do the feet tend to be a focal point when experts talk about skin and diabetes?

Levy: The circulation is the poorest around the toes and on the feet, causing many problems. People with diabetes also tend to have less feeling in their feet and tend to not treat a cut or blister until it gets much worse.

DIABETES HEALTH: What kind of precautions can people with diabetes take to reduce their risk or take care of skin problems?

Levy: The overall thing is good hygiene. First of all, use anti-bacterial soaps, also called deodorant soaps. These include Lever 2000, Dial and Safeguard which all contain antiseptics to lower bacterial/fungal count on the skin.

Bacterial infections need to be treated early and aggressively to prevent progression. In addition to these soaps, a person can use appropriate topical or oral antibiotics.

DIABETES HEALTH: How can fungal infections be avoided?

Levy: Zeasorb powder and Sarna lotion are both anti-fungal, over-the-counter treatments to use for this purpose. Females use them under their breasts to prevent infections. Both of these products will help dry the skin. Also, it’s not good to have the cuticles pushed back when having your nails done. This can cause a yeast or fungal infection.

Poor immunity to bacteria and fungi does not change even if your blood sugar is controlled. There is an unknown relationship to susceptibility for people with type I diabetes-even when they have good control. Type 2 susceptibility, however, does hinge on control.

DIABETES HEALTH: What kinds of lotions do you recommend to treat skin problems?

Levy: Creams are OK as long as they don’t irritate the skin, but it is different for every individual. If a person get cracks on his feet, creams can seal them up. One suggestion is Lack-Hydrin V which is sold over the counter.

Another way to seal up cracks is by using an over-the-counter anti-bacterial ointment such as Polysporin or Bacitracin.

During the winter months, I suggest trying Eucerin cream, Lacticare lotion or Aquaphor. It is so important when a person gets cracking between the toes or on the feet to immediately get something to close it up. Then, go to a podiatrist or dermatologist right away if not healed in a few weeks.

DIABETES HEALTH: What kinds of socks should people with diabetes wear to help control skin problems?

Levy: Stay away from pure nylon, dacron, and wool socks; they can irritate the skin and cause cracks. People should stick to cotton or cotton mixtures.

DIABETES HEALTH: Are there any other things people with diabetes should be concerned with in relation to their skin?

Levy: In general, people with diabetes should screen themselves from the sun and teach their children the same thing. People should teach their children at a young age to always wear a hat in the sun.

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